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Why Some Nursing Homes Are Devastated By COVID-19 While Others Remain Untouched


While nursing home residents and staff account for at least 40% of deaths from COVID-19, many of these facilities have gone virtually untouched. Researchers have been trying to figure out why so that all nursing homes can do a better job going forward. But as NPR's Ina Jaffe reports, their studies draw wildly different conclusions.

INA JAFFE, BYLINE: The federal government writes every nursing home for overall quality using a scale of 1 to 5 stars, and the lowest quality nursing homes have been the hardest hit by the coronavirus according to government officials; some independent researchers have found the same thing. Charlene Herrington at the University of California, San Francisco studied all the nursing homes in the state.

CHARLENE HARRINGTON: The nursing homes before the pandemic that had the most quality problems were not surprisingly the ones that were more likely to get the virus when the pandemic hit because they were so vulnerable.

DAVID GRABOWSKI: We couldn't find any kind of measure of facility quality that was correlated with having a COVID case.

JAFFE: That's David Grabowski, a professor of health care policy at Harvard. What made nursing homes vulnerable to the virus wasn't their quality, he says, but their location.

GRABOWSKI: If you happen to be a five-star facility in a community with lots of cases, it's likely to come into your building. If you're a one-star facility located in an area with very few cases, you're probably not going to have COVID enter your building.

JAFFE: There is one thing that researchers agree on - larger nursing homes with large numbers of African American residents have had the most infections and deaths. But policymakers looking for ways to make that better may not get much help from these studies. That's because they don't agree on solutions anymore than they agree on the causes of the nursing home outbreaks. Charlene Harrington's work leads her to conclude that lawmakers should focus on low-quality nursing homes and inadequate nurse staffing.

HARRINGTON: We found that nurse staffing was a very important factor in whether or not nursing homes had residents with the virus.

JAFFE: That was especially true of nursing homes that were low on registered nurses.

HARRINGTON: Because the RNs are very important for infection control and just the overall quality of the nursing home.

JAFFE: But University of Chicago health economist Tamara Konetzka thinks pressuring low-rated nursing homes with fines and inspections could be a mistake.

TAMARA KONETZKA: In those low-quality facilities, you know, what they probably need most right now is actual resources. And finding them and ramping up inspections is not going to give them the resources they need to fight this pandemic.

JAFFE: Harvard's David Grabowski says the answer is to help all nursing homes.

GRABOWSKI: Every nursing home has lacked personal protective equipment, testing, good infection control, and we've seen this across the continuum.

JAFFE: Choosing the right approach could be a matter of life or death, he says. Meanwhile, the lives of nursing home residents hang in the balance. Ina Jaffe, NPR News. Transcript provided by NPR, Copyright NPR.

Ina Jaffe is a veteran NPR correspondent covering the aging of America. Her stories on Morning Edition and All Things Considered have focused on older adults' involvement in politics and elections, dating and divorce, work and retirement, fashion and sports, as well as issues affecting long term care and end of life choices. In 2015, she was named one of the nation's top "Influencers in Aging" by PBS publication Next Avenue, which wrote "Jaffe has reinvented reporting on aging."